Abstract
The surgical approach to compressive syndromes of the thoracic outlet of vascular or nervous origin represents, for anatomical and historical reasons, an important issue for orthopaedic surgeons. Today’s angiographic techniques give an easy and unequivocal insight of the vascular and non-vascular (indirect) nature of the disease and, consequently, give more solid indications for surgery than before. A series of 35 cases, 21 women and 14 men with an average age of 39 years, of thoracic outlet syndrome (TOS) of vascular origin is presented here. The causes of compression were cervical rib (n=24), soft tissue anomalies (n=10) and scar tissue after clavicular fracture (n=1). During surgery, two subclavian artery aneurysms containing intraluminal thrombus and one subclavian artery occlusion were found. Presenting features of cases with arterial TOS included: hand ischaemia (n=32), transient ischaemic attack (n=3) and claudicatio or vasomotor phenomena during the arm in hyperabduction (n=3). Two patients with venous TOS developed hand oedema during arm hyperabduction, and another patient had axillary-subclavian venous thrombosis. In all cases decompressive procedures using a combined supraclavicular and infraclavicular approachs were performed. Decompression were achieved by cervical rib excision (n=24), combined cervical and first rib excision (n=10) and first rib excision (n=1). In all cases, division of all tissue elements was also accomplished. Associated vascular procedures included resection and replacement of two subclavian aneurysms.
The mean follow-up period was 3 years and 2 months (range 1–6). Complete resolution of symptoms with a return to full activity was achieved in all cases. The medium-term clinical results suggest that the surgical indication for TOS, if supported by digital angiography, is justified and effective.
